Survey of ophthalmology最新文献

The unique nature of the retinal microvasculature that permits non-invasive visualization has garnered interest as a potential method for detecting microvascular alterations indicative of systemic diseases. This concept, supported by advancements in imaging technologies, has been increasingly validated by studies linking retinal microvasculature with systemic conditions such as diabetes, hypertension, and cerebrovascular disease. Structural changes in the retinal microvasculature are associated with cardiovascular risk factors, metabolic diseases, and are significant predictors of systemic hypertensive damage and mortality. Given that most systemic diseases present life-long burdens and complications if undetected or untreated, the development of diagnostic tools like retinal vascular imaging becomes important for early detection, monitoring of disease progression, and facilitating timely interventions. Technological advancements have enabled objective and accurate quantification of retinal microvascular characteristics. We consolidate current literature on retinal vascular changes across various systemic health conditions, including metabolic diseases, cerebrovascular diseases, pregnancy complications, systemic inflammatory conditions, leukemia, human immunodeficiency virus infection, and COVID-19. We also emphasizes the need for dynamic parameters, an understanding of 3-dimensional vascular architecture, and larger-scale longitudinal studies to elucidate the temporal relationship between retinal vascular changes and systemic diseases, helping shape future diagnostic and monitoring approaches.

People with multiple sclerosis (pwMS) encounter numerous ocular complications, including uveitis. MS-related uveitis is linked to diverse complications, encompassing cataracts, cystoid macular edema, band keratopathy, glaucoma, retinal detachment, retinoschisis, vitreous hemorrhage, and occlusive vasculitis. The relationship between uveitis and MS is firmly established, but various prevalence rates have been reported. Hence, this study aimed to determine the overall prevalence of uveitis and its different types among pwMS. The systematic search was conducted across PubMed/MEDLINE, Scopus, EMBASE, and Web of Science to identify studies published between January 1, 1990, and November 11, 2023. The meta-analysis was performed using R software version 4.3.2 with a random-effect model to calculate the pooled prevalence with a 95% confidence interval (CI) of uveitis among pwMS. From a total of 2,520 studies reviewed, 12 studies met the inclusion criteria, comprising a total of 54,402 pwMS. Of whom, 72% were female, and the mean (standard deviation) age was 43.5 (12.1) years. Meta-analysis showed that the pooled prevalence of uveitis among pwMS was 1.1% (95% CI: 0.6% to 1.7%, I²=95%, p-heterogeneity<0.01). Moreover, among various uveitis types, intermediate uveitis exhibited the highest prevalence of 0.6% (95% CI: 0.2% to 1.0%, I² = 87%, p-heterogeneity < 0.01) in pwMS. The current study determined that the prevalence of uveitis among pwMS is 1.1%. Among different uveitis types, intermediate uveitis stands out as the most prevalent in pwMS. The consideration of diagnosing uveitis in pwMS within clinics by specialists is imperative.

Cytomegalovirus retinitis (CMVR) is a significant cause of blindness in patients with advanced acquired immunodeficiency syndrome (AIDS). There are no established guidelines for its treatment, resulting in varied antiviral approaches. We pooled data from 59 studies (4,501 patients) to evaluate treatment variations and outcomes (CRD42022321088). Overall pooled estimates showed visual acuity improvement at 18% (95% CI: 7-41%), inflammation resolution at 90% (95% CI: 81-95%), retinal detachment at 11% (95% CI: 8-14%), and recurrence at 19% (95% CI: 11-31%). The main antiviral treatment approaches identified were: (1) intravenous antivirals alone in 33 studies, (2) intravitreal antivirals alone in 26 studies, (3) oral antivirals alone in 3 studies, and (4) a combination of systemic (oral or intravenous[IV]) and intravitreal antivirals in 7 studies, with varying schemes and durations. Ganciclovir was the predominant antiviral, with intravenous administration being the most reported (in 23 studies), followed by intravitreal administration (in 20 studies). While visual acuity improvement was comparable, inflammation resolution tended to be higher with intravitreal than with IV antivirals, though not statistically significant (88%, 95% CI: 69-96% vs 75%, 95% CI: 35-94%, p = 0.38). Retinitis progression rate for IV ganciclovir was lower than for those without ganciclovir. Inflammation recurrence was significantly lower in antiretroviral (ART)-treated compared to non-ART-treated HIV/AIDS patients (10% (95% CI: 4-20%) vs 33% (95% CI: 19-50%), p < 0.01). Neutropenia, particularly with ganciclovir, was the most reported adverse effect (up to 50%).

A 54-year-old woman with myopia, hypothyroidism, and asthma presented with intermittent double vision. Serum was positive for anti-low density lipoprotein receptor-related protein 4 (LRP4) antibodies suggesting the diagnosis of myasthenia gravis. There was no improvement with pyridostigmine, prednisone, or azathioprine. Over time her double vision became constant, and she was noted to have mild limitation of abduction in both eyes with an esotropia, left hypotropia, and excyclotorsion. Magnetic resonance imaging showed nasal displacement of the superior rectus and inferior rectus muscles, inferior displacement of the lateral rectus muscles and superotemporal globe prolapse consistent with heavy eye syndrome (HES). The differential diagnosis, clinical and radiological manifestations of HES are discussed.

Age-related macular degeneration (AMD) is a leading cause of blindness and visual impairment worldwide. Structural en face optical coherence tomography (OCT) is an innovative imaging technology that has recently attracted interest because of its potential for assessing AMD features. We conducted a comprehensive review of its application in AMD. In neovascular AMD, structural en face OCT can detect exudative activity, monitor the neovascularization area, study the choroid in polypoidal choroidal vasculopathy, and visualize neovascular membranes in pigment epithelial detachments. Moreover, in nonneovascular AMD, this study provides details on geographic atrophy and drusen, the identification of intraretinal retinal pigment epithelium migration, and the detection of different patterns of outer retinal tubulations. Our study revealed that structural en face OCT can provide relevant information on patients with AMD.

The secondary childhood glaucomas are a heterogenous group, often associated with other ocular or systemic abnormalities. These childhood glaucomas are distinct from primary childhood glaucomas, both in terms of their clinical features and their response to conventional treatment. Surgical management can be challenging in children with secondary glaucoma. On average, this group undergo more surgical procedures and revisions than those with primary congenital glaucoma. We provide a synopsis of secondary childhood glaucomas in terms of classification, clinical features, and management strategies, with emphasis on recent developments.

Age-related macular degeneration (AMD) is the leading cause of central visual impairment in the elderly. The exact pathophysiological mechanisms for AMD remain uncertain. Several studies suggest that choroidal abnormalities and alterations are critical in AMD progression. The transition from manual to automated segmentation and binarization techniques has resulted in accurate and precise measurements of different choroidal parameters. These qualitative and quantitative parameters, known as choroidal imaging biomarkers, have advanced from basic vertical subfoveal choroidal thickness to more intricate 3-dimensional choroidal reconstruction methods in the last decade. Therefore, a comprehensive evaluation of choroidal metrics may investigate valuable insights into AMD, potentially guiding the future development of customized therapeutic strategies and personalized patient care in AMD management. We describe the role of different choroidal biomarkers in evaluating patients with AMD and their contribution to management.

Vitreous floaters are visual phenomena resulting from floating opacities inside the eye that disturb vision. The opacities consist of microscopic collagen fibers that aggregate in myopia and during aging. These collagen fibers are then seen as irregular, sometimes worm-like shadows or structures of a translucent to black color. Because of the floating aspect, they tend to follow the movements of the eye, causing distress and having a negative impact on a patient's quality of life due to degradation in contrast sensitivity function. This is referred to as vision degrading myodesopsia (VDM). The overall importance of floaters and their effect on quality of life gained attention in recent years. While the existence of floaters alone is labeled as harmless, there is an increasing group of young people suffering from VDM. This coincides with the growing prevalence of myopia. Indeed, myopia and myopic vitreopathy are the major causes of VDM in the young. This aspect of myopia, however, is often overlooked. We review the current research status in floater formation, quality of life impact, symptom assessment, localization and therapeutic options for vitreous floaters from the perspective of a myopic, potentially younger patient group.

Our aim was to assess the visual outcomes of patients with Leber hereditary optic neuropathy (LHON) harboring the m.11778G>A MT-ND4 mutation who had no treatment (natural history) or received idebenone or lenadogene nolparvovec. Efficacy outcomes included clinically relevant recovery (CRR) from nadir and final best-corrected visual acuity (BCVA). For the natural history and idebenone groups, we performed a systematic review of the literature and available clinical/regulatory reports. For the lenadogene nolparvovec group, all data from phase 3 studies were included. The overall effect and its 95 % confidence interval (CI) were estimated using a random effects model. For each meta-analysis, patients had a mean age of approximately 30 years at vision loss and were mostly (≥78 %) men. The CRR from nadir [95 % CI] at eye level was 17 % [7 %; 30 %] (n=316 eyes), 31 % [24 %; 40 %] (n=313) and 59 % [54 %; 64 %] (n=348) in untreated, idebenone-treated and lenadogene nolparvovec-treated patients, respectively. This gradient of efficacy was also observed with CRR at the patient level and final BCVA. There was a gradient of efficacy in all assessed visual outcomes, more marked for CRR than for final BCVA, with lenadogene nolparvovec gene therapy superior to idebenone treatment, and both superior to the natural history of the disease.

Keratoconus is a common pediatric corneal disease, leading to vision impairment and amblyopia. Compared to its adult counterpart, pediatric keratoconus has an advanced presentation, rapid progression, higher incidence of complications such as corneal hydrops, and greater potential impact on the quality of life. It typically manifests during puberty and can evolve rapidly to more severe stages if left untreated. This rapid progression underscores the importance of early diagnosis through regular screening in pediatric populations and vigilant monitoring of pediatric keratoconus suspects. Concomitant ocular allergies, ocular anomalies, systemic diseases (e.g. syndromes), and poor compliance with contact lenses might impede prompt intervention and frequently postpone rehabilitation. Corneal collagen crosslinking is a crucial intervention in the management of pediatric keratoconus because it strengthens the corneal microstructure and halts the disease progression. When conservative measures fail, keratoplasty remains a viable option with generally favorable outcomes, though with unique challenges in post-operative care, including concerns related to sutures, long-term graft survival and need for repeated examinations under anesthesia. A multidisciplinary approach involving ophthalmologists, optometrists, pediatricians, and other healthcare professionals, focusing on early diagnosis and timely intervention, is essential for the comprehensive management of pediatric keratoconus and to mitigate its impact on children's lives.